SUNDAY, July 29 (HealthDay News) -- New gene mutations associated with the development of melanoma have been identified by scientists who conducted what is believed to be the largest DNA-sequencing study of the deadly disease to date.
Melanoma accounts for the vast majority of skin cancer deaths. The main cause of melanoma is excessive exposure to ultraviolet (UV) radiation from the sun.
The Yale Cancer Center team used DNA-sequencing technologies to analyze 147 melanomas originating on both sun-exposed and sun-shielded sites on patients' bodies. They found a large number of UV-induced mutations in sun-exposed melanomas, but most of these are "passenger" mutations that don't have a functional role in melanoma.
"We devised a mathematical model to sort out the relevant DNA alterations from over 25,000 total mutations," lead study author Michael Krauthammer, an associate professor of pathology, said in a Yale news release.
The researchers pinpointed a mutation in the RAC1 gene that speeds growth and movement in normal skin pigment cells, which are where melanoma begins. The mutation likely occurs at an early stage of melanoma development and promotes cancer cell growth and spread to other sites in the body, they said.
The RAC1 mutation was found in about 9 percent of melanomas from sun-exposed skin. It is the third-most frequent mutation after previously identified BRAF and NRAS mutations. Because the RAC1 mutation is so common, it would be worthwhile to develop treatments that target it, the researchers added.
They also identified mutations that disable proteins that suppress tumors.
The study was published online July 29 in the journal Nature Genetics.
In the United States, about 76,000 new cases of melanoma will be diagnosed this year and about 9,000 people will die of the disease, according to the American Cancer Society.

SUNDAY, July 29 (HealthDay News) -- Parents should not use benzocaine products to relieve teething pain in babies except under the advice and supervision of a health care professional, the U.S. Food and Drug Administration says.
Benzocaine is a local anesthetic found in over-the-counter products such as Anbesol, Orajel, Baby Orajel, Orabase and Hurricane.
The use of benzocaine gels and liquids to relieve gum and mouth pain can lead to a rare but potentially deadly condition called methemoglobinemia, in which the amount of oxygen carried through the bloodstream is greatly reduced. Children under 2 years old are at particular risk for the condition, the FDA said in a news release.
The agency first warned about the potential dangers of benzocaine in 2006 and has since received 29 reports of benzocaine gel-related cases of methemoglobinemia. Nineteen of those cases occurred in children, 15 of them under 2 years of age.
The FDA also noted that parents may have difficulty recognizing the symptoms of methemoglobinemia, which include: pale, gray or blue-colored skin, lips and nail beds; shortness of breath; fatigue; confusion; headache; light-headedness and rapid heart rate.
Symptoms can occur within minutes to hours after benzocaine use, and after using the drug for the first time or after several uses. Parents should immediately call 911 (or the local emergency number outside the United States) if a child has symptoms of methemoglobinemia after being given benzocaine, the FDA said in the news release.
Instead of using benzocaine to ease teething pain, the American Academy of Pediatrics suggests that parents give a child a teething ring chilled in the refrigerator, or use a finger to gently rub or massage the child's gums.

Some noninvasive tests are better than others at detecting coronary artery disease in women

Noninvasive tests (NIT) that produce images of how well the heart is functioning, such as echocardiography and single proton emission computed tomography, more accurately diagnose coronary artery disease (CAD) in women with symptoms suspicious of CAD than electrocardiography, which monitors heartbeats to detect restricted blood flow. That's the conclusion of a new research review from AHRQ's Effective Health Care Program. The review, Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women, found there is insufficient evidence from studies to determine what clinical or demographic factors may influence the diagnostic accuracy, risk determinations, prognostic value, treatment decisions, clinical outcomes, or harms associated with NITs for CAD in women.
Heart disease is the leading cause of mortality for women in the United States, and claims more lives than all forms of cancer combined. Approximately one in three women has some form of this disease. It is estimated that 8.1 million women currently have a history of heart-related issues. Early detection and treatment can potentially reduce deaths attributed to CAD. The American College of Cardiology/American Heart Association recommend NITs for symptomatic women who are at intermediate to high risk for CAD, but not for women who are at low risk.
The AHRQ research review supports these recommendations. The review also found that more research is needed to determine the levels of accuracy based on age, race, sex, and body size on test performance, and the impact of these tests on clinical decisionmaking and patient outcomes.
To access this review and other materials that explore the effectiveness and risks of treatment options for various conditions, visit AHRQ's Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov/.

An updated evidence review from AHRQ's Effective Health Care Program reinforces previous findings that second-generation antidepressants are equally effective in treating major depressive disorder and its symptoms. There is no evidence to support choosing one antidepressant over another based on either greater efficacy or effectiveness. Although second-generation antidepressants are similar in efficacy, they cannot be considered identical drugs. Evidence supports some differences among individual drugs with respect to onset of action, side effects, and some measures of health-related quality of life.
The new report, Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression—An Update to a 2007 Report, reviews the evidence on 13 second-generation antidepressants—bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine. It updates current evidence on the comparative efficacy, benefits, and harms of second-generation therapies in treating patients with major depressive disorder, dysthymia, and subsyndromal depression.
The report also highlights areas for future research, including the need for research on the efficacy of second-generation antidepressants in subpopulations and in patients who have not responded to initial treatments. Read and download the full review and other publications from AHRQ's Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov/.

Provider-patient dialogue could be improved to foster medication adherence in HIV care

Patients' failure to take medications as prescribed often results in failure to meet treatment goals. Even in the case of antiretroviral (ARV) therapies for HIV, where successful treatment is life-saving, many people do not consistently take their medications as prescribed. One concern is that provider communication with patients about medication adherence may not be effective in promoting better adherence.
Researchers analyzed voice recordings of 45 providers interacting with 415 patients with AIDS during clinical visits. Three main findings emerged. First, about 10 percent of utterances concerned antiretroviral treatment, and among those using but reporting non-adherence to ARVs, only about 23 percent of utterances had any ARV problem-solving dialogue. Second, when engaged in ARV problem-solving dialogue, providers used significantly more directives and controlling speech. Third, overall, providers asked relatively few open questions or few questions that elicited patient opinions, values or preferences, and only rarely did they check patients' understanding.
The researchers note that these speech patterns may not be consistent with the concepts of patient-centeredness and shared decisionmaking. However, they also point out that patients with HIV often have a variety of social and clinical problems that make their care a tremendous challenge for providers. It is not surprising, they suggest, that in this context, physicians speak more than patients, tend to ask relatively few open or expressive questions, and rarely check patients' understanding.
The researchers concluded that more effective dialogue would likely result in better treatment outcomes. The study was supported in part by the Agency for Healthcare Research and Quality (HS13903).
See "Provider-patient adherence dialogue in HIV care: Results of a multisite study," by M. Barton Laws, Ph.D., Mary Catherine Beach, M.D., Yoojin Lee, M.S., M.P.H., and others in AIDS Behavior, published online January 31, 2012.

Bowel incontinence and other clinical factors predict the development of pressure ulcers

The elderly are vulnerable to pressure ulcers, particularly when they have limited mobility and cannot ambulate. Once they develop, such ulcers need care and treatment to prevent systemic infections and hospitalization. Identifying which patients are most at risk for pressure ulcers is an important part of prevention. In this study, researchers were able to determine a set of factors that raise the risk of developing pressure ulcers in older home care patients. Information was obtained on 5,395 patients 60 years of age and older who were cared for by 5 home health care agencies. The researchers used data from the Outcome and Assessment Information Set (OASIS), which must be collected in order to receive reimbursement from Medicare and Medicaid. Various details on clinical, functional, and mental health status were extracted that represented potential predictors of pressure ulcer development. Patients were followed until they developed an ulcer or were discharged from home health care.
The cumulative incidence of new pressure ulcers was 1.3 percent. Among the 71 patients who developed an ulcer, there was a higher prevalence of a cancer diagnosis, diabetes, and longer time in home health care. The two top predictors of developing a new ulcer were bowel incontinence and patient inability to transfer self. Other factors included needing assistance with grooming and dressing, dependence in toileting, being bedfast or chairfast, and already having a pressure ulcer at the start of home health care. The usefulness of OASIS data to identify patients most at risk for pressure ulcers can assist agencies to develop prevention protocols and improve quality of care. The study was supported in part by the Agency for Healthcare Research and Quality (HS17353).
See "Outcome and assessment information set data that predict pressure ulcer development in older adult home health patients," by Sandra Bergquist-Beringer, Ph.D., R.N., C.W.C.N. and Byron J. Gajewski, Ph.D., in Advances in Skin & Wound Care 24(9), pp. 404-414, 2011.

Certain medications are associated with functional decline in the elderly

Functional status is the hallmark by which geriatric care is measured. Having a good functional status means an elderly individual can still take part in activities of daily living, be mobile, and engage in various activities including cooking, cleaning, shopping, and managing finances. Medication use is a known risk factor for functional status decline, but a recent review of studies on the topic revealed that some drug classes are associated with greater functional decline than others. The literature review included 19 studies that looked at the relationship between medication use and type and functional decline among older adults. In general, as the number of prescriptions increased, so did functional decline.
Specifically, three of four studies found a negative association between functional decline and the use of benzodiazepines. There was also a relationship found between worse functional status and increasing exposure to anticholinergic medications. Other studies produced mixed results for other drug classes, such as antidepressants and antihypertensives. The study was supported in part by the Agency for Healthcare Research and Quality (HS17695, HS18721, HS19461).
See "Medication use and functional status decline in older adults: A narrative review," by Emily P. Perone, Pharm.D., Shelly L. Gray, Pharm.D., M.S., and Joseph T. Hanlon, Pharm.D., M.S., in the December 2011 The American Journal of Geriatric Pharmacotherapy 9(6), pp. 378-391.

Adverse drug reactions a major cause of unplanned hospitalizations of elderly veterans

Veterans who are age 65 and older and taking multiple medications for various conditions are at risk of adverse drug reactions (ADRs) that can lead to unplanned hospitalizations. In fact, a new study reveals that 10 percent of unplanned hospitalizations among this group were related to ADRs. The study included a group of 678 veterans hospitalized directly from an ambulatory care setting for an unplanned admission. There were 70 ADRs involving 113 drugs in 68 hospitalizations. More than one-third (36.8 percent) of these hospitalizations were considered to be preventable. The researchers estimated that if they applied these findings to the population of more than 2.4 million veterans receiving care during the study period (2003-2006), as many as 8,000 hospitalizations would have been preventable.
Multiple medication use, also known as "polypharmacy," has been shown to be the most consistent and strongest predictor of ADRs in older adults. Overall, 44.8 percent of veterans took nine or more outpatient medications and 35.4 percent took five to eight. The authors suggest that their findings should be useful to highlight areas for future intervention (e.g., reducing inappropriate prescribing by using computerized physician order entry with decision support) to reduce preventable health care use. This study was supported in part by the Agency for Healthcare Research and Quality (HS19461).
See "Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans," by Zachary A. Marcum, Pharm.D., Megan E. Amuan, M.P.H., Joseph T. Hanlon, Pharm.D., and others in the Journal of the American Geriatric Society 60, pp. 34-41, 2012.

No significant link found between treatments used for juvenile idiopathic arthritis and development of cancer

Juvenile idiopathic arthritis (JIA) is an autoimmune disease that usually occurs in children before age 16. It can cause joint pain and swelling, fevers, and rash. Treatment includes therapy with methotrexate (MTX) and tumor necrosis factor (TNF) inhibitors. The latter class of drugs, which inhibit the ability of TNF, an inflammation-producing protein that also can kill cancer cells, has been associated with a risk of malignancy. A new study has found a higher rate of incident malignancy in children with JIA compared to children with attention deficit hyperactivity disorder (ADHD) or asthma. However, the type of treatment for JIA was not significantly associated with a child developing a malignancy.
Researchers used Medicaid claims data obtained from all 50 States and the District of Columbia. Children diagnosed with JIA were identified. Children without JIA who had asthma (652,234) or ADHD (321,821), chronic disorders that are not suspected to be associated with cancer, were used for comparison. The researchers also categorized the children with JIA by their exposure to MTX and TNF inhibitors. Using diagnostic codes, procedure codes, and pharmacy claims, they identified incident malignancies that developed in the children.
Nearly half of the 7,812 children with JIA had taken MTX; one-fifth had taken TNF inhibitors. There were a total of 265 malignancies found: 10 in the JIA group, 68 in the ADHD group, and 193 in the asthma group. Six of the 10 malignancies in the JIA group were identified in children who had not taken MTX, TNF inhibitors, or other immune-system agents. Three malignancies were found in JIA patients taking only MTX; 1 malignancy was found in a child taking a TNF inhibitor for JIA. The standardized incidence ratio was 4.4 for malignancies in the children with JIA compared to children without the disease. No significant association was found between cancer and treatment of JIA with either MTX or TNF inhibitors. The study was supported in part by the Agency for Healthcare Research and Quality (HS17919 and HS18517).
See "Rates of malignancy associated with juvenile idiopathic arthritis and its treatment," by Timothy Beukelman, M.D., M.S.C.E., Kevin Haynes, Pharm.D., Jeffrey R. Curtis, M.D., M.S., M.P.H., and others in the April 2012 Arthritis & Rheumatism 64(4), pp. 1263-1271.

Insulin pumps combined with real-time continuous glucose monitoring (sensor-augmented insulin pumps) are superior to multiple daily insulin injections and self-monitoring of blood glucose (SMBG) with fingersticks to lower high blood sugar in patients with type 1 diabetes.
That's the conclusion of a new research review from the Effective Health Care Program of the Agency for Healthcare Research and Quality (AHRQ). Quality of life was improved with continuous insulin infusion for individuals with type 1 diabetes. Insulin pumps are superior to SMBG in regulating blood sugar when patients wear the sensor at least 60 percent of the time, as indicated by lower levels of blood sugar.
Diabetes is a chronic condition that affects nearly 8 percent of Americans. Of the people who have diabetes, 90 to 95 percent have type 2 diabetes. Type 1 diabetes is characterized by autoimmune destruction of pancreatic islet cells that results in an inability to produce insulin and a need for daily insulin administration to sustain life. Type 2 diabetes is the result of a combination of insulin resistance and impaired insulin secretion by the beta cells of the pancreas. Typically, insulin resistance predominates early, and insulin secretion decreases over time.
Diabetes is associated with increased risk of coronary artery disease, chronic kidney disease, and retinal damage. iabetes can be treated by controlling or monitoring glucose levels in the blood and reducing high blood sugar, which can be managed by insulin therapies, oral medications, and/or through lifestyle and dietary changes.
The research review, Methods of Insulin Delivery and Glucose Monitoring: Comparative Effectiveness, summarizes evidence on the effectiveness of intensive insulin therapies in individuals with type 1 and type 2 diabetes. The review suggests additional research is needed to investigate the effectiveness of these treatments for children with type 1 diabetes, elderly patients, pregnant woman with type 1 or type 2 diabetes, and racially diverse patient populations with type 2 diabetes. To access this review and other materials that explore the effectiveness and risks of treatment options for various conditions, visit AHRQ's Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov/.

Effects of antidepressants on suicidal thoughts and behavior differ by age group

The U.S. Food and Drug Administration has issued black box warnings on the use of antidepressants by children, adolescents, and young adults. These warnings were based on the occurrence of suicidal thoughts and attempts, not on actual suicides. A re-analysis of data from 41 previous studies that included 9,185 patients has found no evidence of increased suicide risk in children and adolescents ages 7-18 receiving active medication. Relative to placebo, depression symptoms lessened among treated patients in this group. However, unlike the older population, there was no greater decrease of suicidal thoughts and behavior in treated versus control subjects.
It's unclear why some youths whose depressive symptoms are reduced continue to have suicidal ideation and behavior. The authors suggest that perhaps other psychopathology, such as aggressive impulsive traits in youths, plays a more important role in this. Nevertheless, the overall rate of suicidal thoughts and attempts was not significantly greater than that of youths randomized to placebo in the study.
The findings were based on a synthesis of 41 adult, geriatric, and youth trials of the antidepressant drugs, fluoxetine and venlafaxine. Only fluoxetine was administered to youth. Despite a strong association between depression severity and suicide risk in youths, treatment with fluoxetine did not decrease suicide risk beyond that observed with placebo. By contrast, with older patients receiving either fluoxetine or venlafaxine treatment, there was a greater reduction in suicide risk relative to control patients receiving placebo. The effect of treatment on depression severity appears to be the mechanism whereby antidepressants lower suicide risk in adult and geriatric patients. This study was supported, in part, by the Agency for Healthcare Research and Quality (HS16973).
See "Suicidal thoughts and behavior with antidepressant treatment. Reanalyis of the randomized placebo-controlled studies of fluoxetine and venlafaxine," by Robert Gibbons, Ph.D., Hendricks Brown, Ph.D., Kwan Hur, Ph.D., and others in the Archives of General Psychiatry published online February 6, 2012.

More patients with anxiety disorders are being prescribed antipsychotic medications by office-based psychiatrists

Antipsychotic agents are increasingly being used to treat a wide range of conditions. Their increased use is due to the ever-expanding Food and Drug Administration's approved indications as well as their inherent sedation properties. This quality has made them attractive in patients with treatment-resistant anxiety disorders. While there is a dearth of information about their effectiveness for anxiety disorders, a new study finds that the use of antipsychotics to treat these conditions has risen dramatically.
Researchers analyzed data over a 12-year period from the National Ambulatory Medical Care Survey that contains information from patient visits to office-based physicians. The sample for this study included 4,166 visits to psychiatrists where there was a diagnosis of an anxiety disorder, including traumatic stress disorders, panic disorders, phobias, and generalized anxiety disorder. Up to six medications mentioned on the medical records were captured, including antipsychotic agents.
Psychiatric visits where an anxiety disorder was diagnosed increased from 21.2 percent in 1996-1999 to 25.7 percent in 2004-2007. During the 12-year study period, prescriptions for antipsychotics during visits in which anxiety disorders were diagnosed doubled from 10.6 percent to 21.3 percent. Most of the increase in this prescribing trend occurred among new patients. Patient characteristics particularly associated with antipsychotic prescribing included younger age, being black, having public insurance, and the presence of a coexisting condition. The biggest jump in antipsychotic prescriptions occurred in patients with panic disorder. Given the side effect profiles of antipsychotics, which can carry metabolic, endocrine, and cerebrovascular risks, the researchers suggest that clinicians limit their use to patients where there is a clear indication. The study was supported in part by the Agency for Healthcare Research and Quality (HS16097).
See "National trends in the antipsychotic treatment of psychiatric outpatients with anxiety disorders," by Jonathan S. Comer, Ph.D., Ramin Mojtabai, M.D., Ph.D., M.P.H., and Mark Olfson, M.D., M.P.H., in the October 2011 American Journal of Psychiatry 168(10), pp. 1057-1065.

SATURDAY, July 28 (HealthDay News) -- Lots of parents would like to avoid having their kids spend the summer watching television or playing video games.
According to the Alliance for a Healthier Generation, reducing the amount of time spent in front of a computer or TV can boost health and happiness, prompting families to do more physical activity and get creative in finding other ways to spend their time.
The nonprofit organization, which was formed to combat childhood obesity, offered tips to cut down on screen time:

Schedule screen time. Decide in advance what shows will be watched, what video games will be played or how much Internet time is allowed.

Keep track. Have children write down the amount of time they spend in front of the TV or a computer screen. If they realize they are spending more time in front of a screen than they thought, they may be motivated to change their habits.

Be positive. Set goals for reducing screen time and offer rewards for reaching them.

Do something else. Go outside, join a club, play a sport, get a hobby.

Designate screen-free time. Don't turn on the TV first thing in the morning. Turn off the TV during dinner. Instead, eat outside or have a family talk. Remove electronics from bedrooms.

Put electronics away. Try storing all electronics in one room for an entire day and not touching them, or cover screens to help you forget about them.

Read instead. Take the kids to the library. Allow children to stay up 15 minutes past their bedtime as a reward for reading.

Liver transplant patients who taper off or do not take corticosteroids after transplantation have better quality of life

Patients who undergo liver transplants show improved quality of life when they receive a drug regimen of immunosuppressant drugs that prevent organ rejection, and also reduce or avoid using corticosteroids for immune suppression, according to a new study. Corticosteroid treatment, used since the beginning of liver transplantation to prevent transplant rejection, can cause both physical problems, such as increased infections and metabolic disturbances, and mental health problems, including insomnia and behavioral and mood disturbances.
Newer antirejection protocols allow clinicians either to taper patients off corticosteroids or avoid their use altogether. To establish the impact of this approach on health-related quality of life (HRQOL), the researchers followed 186 adult patients who received liver transplants. They evaluated their HRQOL before transplantation and at least once after the procedure—for a median of 14 months and up to 6 years after transplantation. Most of the patients (81 percent) had post-transplant HRQOL reported at least twice, depending on the length of followup.
High-dose steroid use (at least 10 mg/day of prednisone or prednisone equivalents) following transplantation was significantly associated with lower scores on the physical component survey (PCS) and mental component survey (MCS), which contribute to a lower overall HRQOL for the patient.
High-dose steroid use was also associated with a significant increase in post-transplant anxiety, but not depression. Values for PCS, MCS, and anxiety at 1 year after transplantation were significantly better when patients were not on steroids than when patients were maintained on high-dose steroids. The researchers recommend the reduction or elimination of corticosteroids from post-transplant maintenance therapy. The findings were based on retrospective analysis of patients who underwent liver transplants at the Vanderbilt University Medical Center from 2002 through 2009. This study was funded in part by a grant from the Agency for Healthcare Research and Quality (T32 HS13833).
More details are in "Reduction in corticosteroids is associated with better health-related quality of life after liver transplantation," by Victor Zaydfudim, M.D., M.P.H., Irene D. Feurer, Ph.D., Matthew P. Landman, M.D., M.P.H., and others in the February 2012 Journal of the American College of Surgeons 214(2), pp. 164-173.

Patients with cardiovascular disease frequently have radiographic procedures involving the use of infused radio-contrast agents. In 3-14 percent of patients, the use of these agents is associated with contrast-induced acute kidney injury (CI-AKI). Radio contrast has been hypothesized to cause AKI through direct toxicity and via hemodynamic changes. A new study has identified ways to reduce CI-AKI in patients with cardiovascular disease. When researchers looked at 10 Northern New England medical centers, they found a fivefold variation in the rates of CI-AKI. Centers with lower rates of CI-AKI were those with strong clinical leadership and aggressive prophylaxis through volume expansion with fluids prior to the procedure.
For example, centers with lower rates of CI-AKI were more likely to bypass the nothing by mouth after midnight in favor of nothing by mouth 4 hours prior to the radiographic procedure and standardizing volume administration protocols in combination with administering three to four high doses of N-acetylcysteine (1200 mg) for each patient.
This study is part of an effort by the Northern New England Cardiovascular Disease Study Group to evaluate the relationship of high-intensity quality improvement efforts on patient safety and CI-AKI. Their next step is to start a high-intensity quality improvement intervention. This study was supported in part by the Agency for Healthcare Research and Quality (HS19443).
See "How do centres begin the process to prevent contrast-induced acute kidney injury: A report from a new regional collaborative," by Jeremiah R. Brown, M.D., Peter A. McCullough, M.D., Mark E. Splaine, M.D., and others in the BMJ Journal of Quality and Safety 21, pp. 54-62, 2012.

Yoga for chronic stroke patients appears to be cost effective and might help them become more active.

EMBARGOED UNTIL 3PM CT/4PM ET, Thursday, July 26, 2012

DALLAS, July 26, 2012 — Group yoga can improve balance in stroke survivors who no longer receive rehabilitative care, according to new research in the American Heart Association journal Stroke.

In a small pilot study, researchers tested the potential benefits of yoga among chronic stroke survivors — those whose stroke occurred more than six months earlier.

“For people with chronic stroke, something like yoga in a group environment is cost effective and appears to improve motor function and balance,” said Arlene Schmid, Ph.D., O.T.R., lead researcher and a rehabilitation research scientist at Roudebush Veterans Administration-Medical Center and Indiana University, Department of Occupational Therapy in Indianapolis, Ind.

The study’s 47 participants, about three-quarters of them male veterans, were divided into three groups: twice-weekly group yoga for eight weeks; a “yoga-plus” group, which met twice weekly and had a relaxation recording to use at least three times a week; and a usual medical care group that did no rehabilitation.

The yoga classes, taught by a registered yoga therapist, included modified yoga postures, relaxation, and meditation. Classes grew more challenging each week.

Compared with patients in the usual-care group, those who completed yoga or yoga-plus significantly improved their balance.

Balance problems frequently last long after a person suffers a stroke, and are related to greater disability and a higher risk of falls, researchers said.

Furthermore, survivors in the yoga groups had improved scores for independence and quality of life and were less afraid of falling.

“For chronic stroke patients, even if they remain disabled, natural recovery and acute rehabilitation therapy typically ends after six months, or maybe a year,” said Schmid, who is also an assistant professor of occupational therapy at Indiana University-Purdue University in Indianapolis and an investigator at the Regenstrief Institute.

Improvements after the six-month window can take longer to occur, she said, “but we know for a fact that the brain still can change. The problem is the healthcare system is not necessarily willing to pay for that change. The study demonstrated that with some assistance, even chronic stroke patients with significant paralysis on one side can manage to do modified yoga poses.”

The oldest patient in the study was in his 90s. All participants had to be able to stand on their own at the study’s outset.

Yoga may be more therapeutic than traditional exercise because the combination of postures, breathing and meditation may produce different effects than simple exercise, researchers said.

“However, stroke patients looking for such help might have a hard time finding qualified yoga therapists to work with,” Schmid said. “Some occupational and physical therapists are integrating yoga into their practice, even though there’s scant evidence at this point to support its effectiveness.”

Researchers can draw only limited conclusions from the study because of its small number of participants and lack of diversity. The study also didn’t have enough participants to uncover differences between the yoga and control groups. The scientists hope to conduct a larger study soon.

Researchers also noticed improvements in the mindset of patients about their disability. The participants talked about walking through a grocery store instead of using an assistive scooter, being able to take a shower and feeling inspired to visit friends.

“It has to do with the confidence of being more mobile,” Schmid said. Although they took time to unfold, “these were very meaningful changes in life for people.”

Follow @HeartNews on Twitter for the latest heart and stroke news. For stroke science, follow the Stroke journal at @StrokeAHA_ASA .

###

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding .

FRIDAY, July 27 (HealthDay News) -- Women who have their last child after age 30 have a reduced risk of endometrial cancer, according to a new study.
Endometrial cancer occurs in the tissue lining the uterus (womb) and is the most common gynecological cancer in the United States.
Researchers examined data from more than 8,600 women with endometrial cancer and more than 16,500 without the disease. The analysis revealed that the risk of endometrial cancer decreased after age 30 by about 13 percent for each five-year delay in last births.
Compared to women who had their last child before age 25, those who had their last child between ages 30 and 34 had a 17 percent reduced risk of endometrial cancer, those who gave birth to their last child between ages 35 and 39 had a 32 percent lower risk, and those who gave birth at age 40 or older had a 44 percent lower risk.
This protection persisted for many years and was the same for both types of endometrial cancer: the more common type 1 endometrial cancer and the more rare and aggressive type 2.
"While childbearing at an older age previously has been associated with a lower risk of endometrial cancer, the size of this study definitively shows that late age at last birth is a significant protective factor after taking into account other factors known to influence the disease -- body weight, number of kids and oral contraceptive use," principal investigator Veronica Setiawan, an assistant professor of preventive medicine at the Keck School of Medicine at the University of Southern California, said in a Keck news release.
However, when the researchers looked at the women by race/ethnicity, they found that association between older age at last birth and protection against endometrial cancer was evident among white and Hispanic women, but not among the small number of black women in the study. This finding warrants further research with larger groups of black women, Setiawan said.
The study was published online July 23 in the American Journal of Epidemiology.
Endometrial cancer is the fourth most common cancer diagnosed in American women. In 2012, more than 47,000 U.S. women will be diagnosed with uterine cancers and more than 8,000 will die of such cancers, according to the American Cancer Society.

By Genevra Pittman
NEW YORK (Reuters Health) - A new, small study suggests medicinal marijuana may impair users' driving skills - but might be missed by typical sobriety tests.
At doses used in AIDS, cancer and pain patients, people weaved side to side more and had a slower reaction time in the hours after using the drug, researchers from the Netherlands found.
For people who hadn't built up a tolerance to marijuana, those effects were similar to driving with a blood alcohol content of 0.08, the point at which drivers are considered legally impaired, they said.
"At this time, we know very little about the possible effects that medical marijuana may have on, say, motor vehicle crash rates, injury rates and mortality rates," said Dr. Guohua Li, who has studied marijuana and traffic accidents at Columbia University in New York but wasn't involved in the new research.
"There is a concern medical marijuana may interact with other drugs such as alcohol that may further compromise driving safety," he added.
The new study involved 12 frequent marijuana users and 12 occasional (three times a month at most) smokers. At three different points, researchers led by Wendy Bosker of Maastricht University gave each of the participants either a 20 milligram or 10 mg pill of dronabinol - medical marijuana - or a drug-free placebo pill.
Two to four hours later, participants completed a series of driving tests, including trying to maintain a constant speed and drive in a straight line, or follow at a constant distance behind another car. They also went through a typical highway sobriety test, involving walking and turning and balancing on one leg.
Participants tended to weave a few centimeters side to side when under the influence, but the impairment was smaller in those who were used to doing pot regularly. After using medical marijuana people also took a second or so longer to react when following another car - although that effect could have been due to chance, the researchers reported in the journal Addiction.
The highway sobriety tests, however, didn't pick up any impairment due to marijuana.
LAWS
Dronabinol, marketed as Marinol, is intended to have a slower onset than pot used recreationally and can leave people feeling "high" hours after they take it.
"It lasts longer in the oral form, so people are likely to remain impaired for longer periods," said Dr. Barth Wilsey, who studies marijuana for pain relief at the University of California, Davis.
Wilsey, who didn't work on the new study, noted that the doses of dronabinol used in it were the highest allowed, and patients usually are started on lower doses.
"You can go to once a day dosing at bedtime, two and a half milligrams if you're having side effects," he told Reuters Health - and then impairment while driving wouldn't be a concern.
Generic dronabinol costs about $4 for each low-dose pill, or up to $15 per high-dose pill.
Medical marijuana is currently legal in 17 states and Washington, D.C.
Li told Reuters Health most states that have legalized medical marijuana have a provision under the law that people shouldn't drive under the influence.
How well that provision is enforced, and how closely people who use medical marijuana comply with it, is another question, Li said. As the new study shows, "There's no easy way right now to tell if someone is under the influence of marijuana."
Researchers are working on such tools, Li said, but they may be years away from being ready for use in the real world.SOURCE: http://bit.ly/MkUmR0 Addiction, online July 12, 2012.

FRIDAY, July 27 (HealthDay News) -- Getting good-quality sleep could help elderly people stay out of nursing homes, a new study contends.
Researchers assessed the sleep quality of nearly 1,700 older women with an average age of 83, and tracked how many were admitted to nursing homes within five years.
"Sleep disturbances are common in older people," lead author Adam Spira, assistant professor in the department of mental health at Johns Hopkins University Bloomberg School of Public Health in Baltimore, said in a university news release.
"Our results show that in community-dwelling older women, more fragmented sleep is associated with a greater risk of being placed in a nursing home or in a personal-care home," Spira said. "We found that, compared to women with the least fragmented sleep, those who spent the most time awake after first falling asleep had about three times the odds of placement in a nursing home."
The researchers found similar associations between disturbed sleep and an increased likelihood of placement in personal-care homes, such as assisted-living facilities. The number of hours women slept each night, however, did not affect the chances of being placed in a nursing home or a personal-care home.
The study was published in the July issue of the Journal of the American Geriatrics Society.
Previous research has linked disturbed sleep in older adults with disability, reduced mobility and difficulty doing daily activities, the authors noted in the news release. The new study adds to this knowledge.
"Greater sleep fragmentation is associated with greater risk of placement in a nursing home or personal-care home five years later after accounting for a number of potential confounders," study senior author Dr. Kristine Yaffe, professor of psychiatry, neurology, and epidemiology and biostatistics at the University of California, San Francisco, said in the news release.
Although the study found an association between sleep quality and nursing-home admission, it did not prove a cause-and-effect relationship.

SOURCE: Johns Hopkins University Bloomberg School of Public Health, news release, July 2012

FRIDAY, July 27 (HealthDay News) -- Men with prostate cancer are more likely to die from other conditions, such as heart disease, than from their cancer, a new study finds.
Living a healthy lifestyle that helps prevent chronic diseases can prolong life even among men with prostate cancer, the researchers added.
"Our study is the first to analyze specific causes of death among men with prostate cancer," said lead researcher Mara Epstein, a postdoctoral researcher at the Harvard School of Public Health in Boston.
Most men who died from prostate cancer over several decades of the study were men diagnosed when they were older or diagnosed before the advent of screening for prostate-specific antigen (PSA), she noted.
"We hope the study will have an impact on the clinical management of men who receive a diagnosis of prostate cancer," Epstein said.
"We hope it will encourage physicians to use the diagnosis as a teachable moment to encourage men to modify lifestyle factors, like losing weight, increasing physical activity and stopping smoking," she explained. "We believe that adopting a healthier lifestyle may reduce a man's risk of other chronic medical conditions that ultimately account for more deaths among men with prostate cancer than the disease itself."
The report was published July 25 in the online edition of the Journal of the National Cancer Institute.
For the study, Epstein's team used the U.S. Surveillance, Epidemiology, and End Results Program and the Swedish Cancer and Cause of Death registries to collected data on the causes of death among more than 700,000 men.
U.S. deaths were for 1973 through 2008; for Swedish men it was 1961 through 2008, the team noted.
Over these periods, 52 percent of the Swedish men with prostate cancer died, as did 30 percent of American men with prostate cancer in the study.
Of these deaths, however, only 35 percent of the Swedish men died directly from prostate cancer and only 16 percent of American men died from the disease itself, the investigators found.
In addition, as the study continued, fewer men died from prostate cancer while deaths from heart disease remained the same.
By the last five years of the study, 29 percent of Swedish men with prostate cancer died from it as did 11 percent of American men, the researchers calculated.
Deaths from prostate cancer varied by age and year of diagnosis. The most deaths were among older men and among men diagnosed before screening for PSA began, they added.
With PSA screening, prostate cancer was diagnosed early and more low-risk cancers were identified, the researchers explained.
Dr. Durado Brooks, director of prostate and colon cancer at the American Cancer Society, said that "this is a lot of reinforcement for a lot of information we already know about. Many more men die with prostate cancer than from prostate cancer."
Brooks added that "prostate cancer is largely a disease of older men, and many of the men who are diagnosed have other medical problems that end up killing them."
Most prostate cancers are slow-growing, and therefore not lethal. In a recent study it was reported that only about 10 percent of men die from prostate cancer whether they receive treatment or not, he noted.
For Brooks, these findings argue against PSA screening, which too often "leads down the path of unnecessary treatment."
"Men should understand that not every prostate cancer needs to be found and every prostate cancer that's found does not necessarily need to be treated," he said.
Another expert, Dr. Louis Kavoussi, chairman of urology at North Shore-LIJ Health System, The Arthur Smith Institute for Urology in Lake Success, N.Y., added that "prostate cancer does kill and if you pick it up early, it can be treated."
The problem with PSA screening is that too many men are treated when they don't have to be, he said. "It's not bad to detect prostate cancer. The bad thing is that you treat everybody," Kavoussi suggested.
"We need to become smarter about who actually needs to be treated and when people need to be treated," he added.
Many men don't need to be screened, Kavoussi said. Those who should be screened are men with a family history of prostate cancer, blacks and anyone else at high risk, he noted.